Classification of angina has been present in the main types of views of a relatively uniform, and more use of the World Health Organization angina classification as a benchmark; but in the detailed sub-types are not yet unified, this article summarizes the current domestic literature several major typing methods, only a total of reference:
(1) World Health Organization angina classification:
1, exertional angina: a result of campaigns or other ways of increasing myocardial oxygen demand induced by short-term situation of onset of chest pain by rest or sublingual nitroglycerin, the pain usually disappears rapidly. Angina pectoris can be divided into three categories: newly diagnosed angina pectoris, the course in 1 month or less; (2) stable angina pectoris: a stable and in the course of a month or more; (3) deterioration of angina pectoris: the same degree of fatigue induced by the onset of chest pain frequency, severity and duration of the sudden increase.
2, spontaneous angina pectoris: chest pain and myocardial oxygen demand, no obvious relationship between the increase. With exertional angina pectoris compared to the level of pain usually last longer heavy, and difficult for the mitigation of nitroglycerin. No changes in myocardial enzyme inspection. Often appear in some temporary ECG ST-segment depression or T wave changes. It can occur in isolation or in combination with exertional angina pectoris.
Spontaneous pain in patients with angina pectoris due to frequency, duration and degree of pain may have different clinical manifestations, and sometimes patients may have a longer duration of chest pain, similar to myocardial infarction, but there is no characteristic ECG and enzyme changes. Some spontaneous attack of angina pectoris occurs in patients with transient ST-segment elevation, often referred to as variant angina, myocardial infarction in the electrocardiogram recorded in graphics, we can not use this name. In primary exertional angina, worsening angina pectoris and spontaneous angina pectoris often collectively referred to as "unstable angina."
(B) According to the natural course of angina pectoris classification
1, stable angina pectoris: is the duration of stable angina pectoris more than one month;
2, unstable angina pectoris: including the initial issuance of exertional angina, worsening angina pectoris and spontaneous angina pectoris (including variant angina).
(C) Common angina classification:
1, exertional angina is characterized by pain from physical exertion, emotional excitement, or other circumstances sufficient to increase myocardial oxygen demand induced by rest or sublingual nitroglycerin after the fast disappearing. Include:
(1) stable angina pectoris: duration of angina for more than 1 month but stable condition unchanged, their angina threshold is fixed, in a certain physical activity or emotional excitement caused by angina that may be repeated. Angina pectoris in the labor of a certain time, rather than after work.
(2) the early onset angina: angina pectoris refers to the initial attack, the course in 1 months or less. Have had stable angina pectoris in patients with a history of angina does not occur for several months now the recurrence of angina and time not yet reached the 1 month, can also be included in this model.
(3) deterioration of angina pectoris: The original of stable angina patients, angina in 3 months, the frequency, intensity, duration, induced factors are often changes and progressive deterioration.
(4) decubitus angina: refers to patients in supine, quiet state, caused by angina pectoris. The traditional view would be as spontaneous angina pectoris decubitus a type that, when it occurs with the supine blood Rhodobryum roseum-induced increase in left ventricular failure, which in turn is the application of the indications of digitalis drugs. At present there is new understanding of the decubitus angina: different states of cardiac function (heart function was normal, diastolic dysfunction and left ventricular dysfunction), the onset of angina decubitus are due to increase in myocardial oxygen consumption, not myocardial a decrease in blood supply. Therefore, decubitus angina pectoris angina pectoris should be the scope and should be differentiated with spontaneous angina pectoris, the treatment has its own uniqueness.
2, spontaneous angina pectoris: its occurrence by the pain caused by coronary artery spasm, myocardial oxygen consumption increased with no significant relationship. Level of pain, heavier, longer time-frame is not easy for the ease with nitroglycerin. ECG often appear in some transient ST-segment depression or T wave changes. Pseudo-angina pain and episodes of spontaneous frequency, duration and degree of pain may have different clinical manifestations may occur in isolation or in combination with exertional angina pectoris. There are several special types:
(1) variant angina: clinical manifestation and angina decubitus similar, but the attack on electrocardiogram showed ST-segment elevation, corresponding to the lead while ST segment depression. As the main branches of coronary artery spasm caused by wearing a mural myocardial ischemia complicated by AMI or sudden death.
(2) simple type of spontaneous angina pectoris: clinical manifestations and variant angina is similar, but the attack electrocardiogram showed ST segment depression, expressed as subendocardial myocardial ischemia. Ischemic attack with the following factors may be relevant: the main branch of coronary artery spasm, or small branches, but accompanied by a rich collateral circulation, did not lead to myocardial ischemia through the partition, so ECG showed ST-segment depression alone.
(3) postinfarction angina: AMI refers to within 1 month after the occurrence of angina pectoris reappeared. In addition to myocardial necrosis has been infarction, the part has not yet suffering from severe ischemic myocardial necrosis took place in a state of pain. Attack with the following factors may be relevant: the existence of infarct-related coronary artery accompanied by severe residual stenosis or plaque rupture, instability thrombosis, vascular spasm, and insufficient collateral circulation, myocardial infarction-prone areas in the near future to expand or re - Fat myocardial infarction.
3, mixed angina pectoris: the angina pectoris and spontaneous angina pectoris in combination. Patients with either an increase in myocardial oxygen consumption occurs when the angina, can also be no significant increase in myocardial oxygen consumption occurs when the angina pectoris. Such patients are often fixed stenosis in coronary artery thrombosis on the basis of instability, leading to a cyclical coronary blood flow reduction, probably due to continuous mural thrombus and platelet formation and loss, and coronary artery spasm related.
(C) Other Angina sub-types:
Some people with angina patients with in-depth observations in recent years to some of the types of angina will now be summarized as follows in three categories:
1, tiredness of angina is determined by movements or other circumstances of increased myocardial oxygen demand induced angina. Including 3 types:
(1) tired of stable angina pectoris: short stable angina (stable anina pectoris), also known as ordinary angina pectoris, is the most common angina. Refers to myocardial ischemia and anoxia caused by a typical angina pectoris, the nature of the 1 ~ 3 months has not changed. A daily and weekly number of pain episodes or less the same, the pain induced by fatigue and emotion to the same degree, the nature of each attack of pain and pain in parts of no change, pain similar time frame (3 ~ 5 minutes), without up to 10 ~ 20 minutes or more, with the same amount of time, also after nitroglycerin effects occurred.
The attack of angina pectoris, the patient expression of anxiety, skin pale, cold, or sweating. Blood pressure may be slightly higher or lower, apex area may have systolic murmur (mitral valve papillary muscle dysfunction caused by). The second heart sound may have against the division, but also there are alternating pulse or heart beat and so on before the district signs of sexual favors.
The patient at rest for more than 50% of the ECG is normal, abnormal ECG, including ST segment and T wave changes, atrioventricular block, bundle branch block, left bundle branch block or after the branch supporting the front, left ventricular hypertrophy or arrhythmias such as Sometimes, old myocardial infarction array performance. ECG during pain episodes can be showed typical ischemic ST segment depression changes.
(2) the early onset exertion angina: the early short hairstyle angina. Means the patient has not occurred in the past, angina pectoris or myocardial infarction, and now occurs from myocardial ischemia and anoxia caused by angina, the time is still 1 to 2 months. Have had stable angina but does not occur for several months the recurrence of angina pectoris patients, it was also included in this model.
The nature of angina pectoris, possible signs, ECG and X ray discovery, with stable angina pectoris, but with angina pectoris is still a ~ 2 months. After the majority of patients displayed stable angina pectoris, but may also develop into worsening angina, or myocardial infarction.
(3) deterioration of type exertion angina: short worsening angina, also known for angina. Refers to the original stable angina patients, the pain within 3 months the frequency, intensity, induced factors are often changes, progressive deterioration of the patient's pain threshold gradually decreased, so less physical activity or emotional excitement that can cause attack, it increase the number of seizures, pain level higher than the drama, episode extension of the time may be more than 10 minutes after using nitroglycerin can not make the pain immediately or completely eliminated. Attack ECG showed marked ST segment depression and T wave inversion, but the attack is working again, and does not appear myocardial infarction changes.
The angina pectoris has been reflected in the development of coronary artery disease, prognosis is poor. Can be developed for acute transmural myocardial infarction, some patients may actually have occurred in young myocardial infarction (non-transmural) or scattered foci of subendocardial myocardial infarction, but failed to be reflected in the ECG only. Sudden death may also occur. But there are also a part of many years of suffering from stable angina patients in a phase of progressive angina pectoris presented by drama, and then a gradual restoration of stability.
By exertion angina occurs when the situation, but also to the severity of angina were divided into four: ① Ⅰ level: daily activities in the asymptomatic. Daily activities compared with heavy physical activity, such as The little jogging or fast, or holding heavy objects on the third floor, on the steep slopes, etc. caused by angina. ② Ⅱ level: daily activities slightly restricted. General physical activity, usual walking speed 1.5 ~ 2 km, on the third floor, uphill and so gives rise to angina pectoris. ③ Ⅲ level: daily activities significantly impaired. Compared with light physical activity daily activities as usual walking speed of 0.5 ~ 1 km, on the second floor, Upper Xiao-Po, etc. gives rise to angina pectoris. ④ Ⅳ level: mild physical activity (such as in indoor put on hold), or caused by angina, severe angina at rest also.
2, spontaneous angina: angina pectoris and myocardial oxygen demand, no obvious relationship with exertion angina compared with an extended duration of pain, degree heavy, and difficult for the mitigation of nitroglycerin. Includes four types:
(1), angina decubitus: also known as angina at rest. Means a break or when angina occurs when asleep, its longer onset of symptoms is also heavier, attack and physical activity or emotional excitement no significant relationship, often seen in the middle of the night, occasionally nap or rest in the attack. Often severe unbearable pain, the patient irritability, get up and walk around. Signs and ECG changes than those with stable angina pectoris clear that the efficacy of nitroglycerin was not obvious, or only temporary relief.
The angina may be stable angina pectoris, early onset or worsening angina pectoris evolved sicker, the prognosis is very poor, can be developed for acute myocardial infarction or severe arrhythmia and death. Still controversial mechanism of its occurrence may be related to Night's Dream, nocturnal blood pressure lowering or left ventricular failure occurred undetected, resulting in a narrow coronary artery distal myocardial perfusion is inadequate; or increased venous return when supine, heart volume increases, the need increased oxygen and other relevant.
(2) variant angina: This type of angina pectoris patients with angina decubitus similar in nature, often during the night attack, but attack the performance of different ECG, showed that the lead of the ST-segment elevation, while the of the corresponding leads in the ST segment depression (other types of angina, unless the addition of lead aVR and V1 widespread ST-segment depression). At present, sufficient information to prove that this angina pectoris due to coronary artery stenosis is based on the branch blood vessel spasm, causing a myocardial ischemia caused. However, patients with normal coronary angiography may also be due to the artery spasm caused by this type of angina, coronary artery spasm may be related to α-adrenergic receptors are stimulated the patient will happen sooner or later myocardial infarction.
(3) Intermediate Syndrome: also known as coronary insufficiency. Refers to angina pectoris due to myocardial ischemia lasted longer, up to 30min to 1 hour or more, seizures often occur at rest or sleep, but the electrocardiogram, radionuclide and serological examination without myocardial necrosis performance. The nature of this type pain between angina and myocardial infarction is between is often a prelude to myocardial infarction.
(4) infarction angina: soon after acute myocardial infarction or angina occurred after a few weeks. As the blood of coronary obstruction, myocardial infarction, but not yet fully myocardial necrosis, some are not suffering from severe ischemic myocardial necrosis took place in a state of pain, recurrence of infarction at any time possible.
3, mixed angina: fatigue and spontaneous angina appears mixed, from coronary artery disease so that a fixed reduction in coronary flow reserve, while a brief re-impairment caused by both fatigue and spontaneous The clinical manifestations of angina pectoris. Some people think that the angina is very common in clinical practice real.
In recent years, more widely used clinically unstable angina pectoris the term refers to between stable angina pectoris and acute myocardial infarction and sudden death between the clinical status, including early onset and worsening of angina-type exertion, and Including various types of spontaneous angina pectoris. The pathological basis of the original lesion on the coronary artery intimal hemorrhage, atherosclerotic plaque rupture, platelets or fibrin coagulation, coronary artery spasm and so on.